Citation Nr: 18143730 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 15-18 437A DATE: October 22, 2018 ORDER Entitlement to a rating in excess of 30 percent for migraine headaches is denied. REMANDED Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder is remanded. Entitlement to service connection for an undiagnosed illness manifested by joint pains to include fibromyalgia is remanded. FINDING OF FACT The Veteran’s service-connected migraine headaches are shown to be productive of severe economic inadaptability. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for service-connected migraine have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.2, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for August 2002 to August 2006. 1. Entitlement to a rating in excess of 30 percent for migraine headaches is denied. The Veteran contends that a rating in excess of 30 percent is warranted for service connected migraine headaches. He reported that he has lost time from work as well as lost free time due to the headaches and that they are completely prostrating. Diagnostic Code 8100 provides ratings for migraine headaches. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. 38 C.F.R. § 4.124a. The rating criteria do not define “prostrating”; nor has the Court. By way of reference, the Board notes that according to WEBSTER’S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION (1986), p. 1080, “prostration” is defined as “utter physical exhaustion or helplessness.” A very similar definition is found in DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1367 (28th Ed. 1994), in which “prostration” is defined as “extreme exhaustion or powerlessness.” Rather than applying a mechanical formula, VA must evaluate all evidence to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. An October 2011 VA examination report shows that the Veteran was diagnosed with migraine headaches. The Veteran reported the headaches occurred six to seven times per month, and lasted approximately twelve hours in duration. He reported that his headaches were associated with photophobia and nausea but no vomiting. The examiner diagnosed the Veteran with prostrating migraine headaches, about six per month that prevented him from working those six days. A September 2013 VA examination report shows that the Veteran reported headaches occurring one to two days per week. No prostrating features were reported. He reported that his headaches were relieved by lying in a cool dark room. The examiner reported symptoms of head pain, and sensitivity to light and sound. Headaches were noted to last one to two days. The examiner remarked that the Veteran did not have characteristic prostrating attacks of migraine head pain. The examiner reported that the Veteran’s headache condition did not impact his ability to work. A June 2016 VA examination report shows the Veteran’s treatment plan included the use of medication. Constant head pain was noted. The examiner noted that the Veteran had symptoms of nausea, vomiting, sensitivity to light and sound, and changing in vision. The examiner reported that the Veteran experienced approximately one prostrating migraine attack per month, but found that the migraine headaches did not affect his ability to work. The examiner also explicitly found that the Veteran’s migraine headaches were not productive of severe economic inadaptability. The Board finds that a rating in excess of 30 percent is not warranted for migraines under Diagnostic Code 8100. There is evidence that the Veteran has frequent migraines, and that at times they are prostrating. However, the evidence is insufficient to show that the Veteran’s migraines are productive of severe economic inadaptability. In this regard, the evidence indicates that the Veteran that while the Veteran has had to miss work of up to six days per month, however, no economic inadaptability has been shown or reported. The Board notes that VA examinations concerning his psychiatric disability shows that the Veteran was employed with the Federal Government as a data entry specialist, and there were no reports of negative effects of migraines on his job. Additionally, the VA examination reports show that the Veteran’s migraine conditions have not affected his ability to work. The Board has carefully considered the Veteran’s contentions with respect to the nature of his service-connected migraines and notes that his lay testimony is competent to describe the symptoms associated with such disability. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and has been contemplated by the 30 percent disability rating that has been assigned. Moreover, the competent medical evidence consisting of the VA examination reports of record, offering detailed specific findings pertinent to the rating criteria that is the most probative evidence with regard to evaluating the pertinent symptoms of his migraines. Based on the above, the Board finds that the Veteran’s migraines are more consistent with the currently assigned 30 percent rating as they are not shown to be productive of severe economic inadaptability. REASONS FOR REMAND 1. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. With respect to the Veteran’s claim for an increased rating for PTSD, the Board notes that a recent correspondence dated October 4, 2018 from the RO indicates that the severity of the Veteran’s condition may have changed and has started to schedule the Veteran for a new VA examination. As to RO’s correspondence references VA treatment records that have not been associated with claims file and that a new VA examination regarding PTSD was being scheduled, the Board finds that this new evidence will be pertinent to issue of an increased rating and the proper course will be to remand this issue to assure that updated VA psychiatric treatment records and any new VA examination report are associated with the claims file. 2. Entitlement to service connection for an undiagnosed illness manifested by joint pains to include fibromyalgia is remanded. The Veteran is seeking service connection for fibromyalgia, and an April 2012 private treatment record does note a “working diagnosis” of fibromyalgia. However, while fibromyalgia is listed frequently in the past medical history sections of VA treatment records, the more recent medical evidence suggests that the diagnostic criteria for fibromyalgia have not been met by the Veteran’s symptoms. For example, at a June 2016 VA examination, the examiner concluded based upon review of Veteran’s service treatment records, VA treatment records, private treatment records, and Gulf War fact sheet, that a diagnosis of fibromyalgia was not warranted. The examiner acknowledged that the Veteran had several symptoms that may co-exist with the diagnosis of fibromyalgia (along with numerous other conditions such as depression and migraine headaches), but found that the physical examination failed to show any evidence of “tender points” which was a necessary symptom for fibromyalgia. The examiner also noted that the Veteran’s private rheumatologist did not submitted any records that would substantiate the diagnosis of fibromyalgia. This conclusion was also reached by a rheumatology doctor in March 2017 who diagnosed the Veteran with chronic pain syndrome due to sleep disturbance, and noted that while the Veteran had negative tender points, in other ways he had classic fibromyalgia. Here, the Veteran has complained of joint pain throughout his appeal period, although it is noted that the Veteran is also service connected for a back disability with radiculopathy into the lower extremities. As such, an opinion is needed to assess whether the Veteran has an undiagnosed illness or medically unexplained chronic multi-symptom illness, other than fibromyalgia, as a result of his service in the Persian Gulf region. The matters are REMANDED for the following action: 1. Obtain a medical opinion to determine the appropriate diagnosis for the Veteran’s complaints of joint pain. If the Board’s questions cannot be answered without a physical examination, one should be scheduled. The examiner should determine whether it is at least as likely as not (50 percent or greater) that the Veteran’s complaints of joint pain support the diagnosis of either an undiagnosed illness or a medically unexplained chronic multi-symptom illness. Why or why not? 2. If not already scheduled and completed, schedule the Veteran for a VA psychiatric examination to determine the current severity of the service connected PTSD. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Dworkin, Associate Counsel